白血病眼部表现及治疗相关眼部不良反应研究进展  

Ocular manifestations of leukemia and ocular side effects of its treatments

作　　者：黄泽宇(综述) 陈辉[1] 季敏(审校)[1] Huang Zeyu;Chen Hui;Ji Min(Department of Ophthalmology,Affiliated Hospital of Nantong University,Nantong 226000,China)

机构地区：[1]南通大学附属医院眼科,南通226000

出　　处：《中华实验眼科杂志》2024年第6期587-592,共6页Chinese Journal Of Experimental Ophthalmology

基　　金：国家自然科学基金(81670852);中国博士后科学基金面上项目(2017M610343)。

摘　　要：白血病是血液系统常见的恶性肿瘤,许多患者可有眼部表现,部分患者可因视力损害或眼部病变首诊于眼科。白血病可通过直接浸润或由于贫血、血小板减少、血黏度增高、免疫抑制等间接因素累及眼前节、玻璃体、视网膜、视神经、脉络膜、眼眶等眼组织,特征性眼部表现包括Roths斑、绿色瘤等。不同类型白血病对眼部的损害概率和侵犯部位不尽相同,急性较慢性、髓细胞较淋巴细胞白血病出现眼部病变的概率高。近年来,白血病的治疗取得了较大进展,特别是抗白血病靶向药物、造血干细胞移植的广泛应用等,但白血病患者生存周期明显延长的同时,也可能引起或加重眼部病变,如酪氨酸酶抑制剂类药物可导致眶周水肿、阿糖胞苷具有角膜毒性、甲氨蝶呤引起眼外肌麻痹、造血干细胞移植后干眼高发等,在很大程度上影响到患者的生存质量。因此,重视白血病相关眼病的诊治具有重要的临床意义。本文就白血病的眼部表现及其治疗引起的眼部不良反应进行综述。Leukemia is a common malignancy of the hematologic system.Many patients may have ocular manifestations,and even some patients are initially diagnosed in the ophthalmology department because of visual impairments or ocular disorders.Leukemia affects almost all ocular tissues such as anterior segment,vitreous body,retina,optic nerve,choroid,and orbit through direct infiltration or indirect factors including anemia,thrombocytopenia,elevated blood viscosity,immuno-suppression etc.The characteristic ocular manifestations include Roths spots,chlorosarcoma and so on.The likelihood of ocular involvement and the site of invasion varies with the type of leukemia,with acute leukemia more likely than chronic leukemia and myeloid leukemia more likely than lymphoblastic leukemia.Due to the advances in treatment of leukemia,especially anti-leukemia targeted drugs and hematopoietic stem cells transplantation,patient survival has been significantly prolonged.At the same time,the treatments can also cause or aggravate ophthalmic conditions.For example,tyrosinase inhibitor drugs can cause periorbital edema,cytarabine has corneal toxicity,methotrexate causes paralysis of extraocular muscles,and keratoconjunctivitis sicca is very likely to occur after hematopoietic stem cell transplantation.These side effects greatly affect the patient's quality of life,so ophthalmologists should pay more and more attention to leukemia-related eye diseases.The ocular manifestations of leukemia and ocular side effects of its treatments are reviewed in this article.

关 键 词：白血病 眼部表现 治疗 眼部不良反应 移植物抗宿主病 

分 类 号：R733.7[医药卫生—肿瘤] R771.3[医药卫生—临床医学]